Demonstration by Magnetic Resonance of Symptomatic Spinal Epidural Lipomatosis

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 414-415 ◽  
Author(s):  
Mark E. Healy ◽  
John R. Hesselink ◽  
Richard C. Ostrup ◽  
John F. Alksne
Keyword(s):  
Magnetic Resonance ◽  
Cushing’S Syndrome ◽  
Cord Compression ◽  
Cushing's Syndrome ◽  
Resonance Imaging ◽  
Epidural Fat ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural ◽  
Excessive Accumulation ◽  
Iatrogenic Cushing’S Syndrome

Abstract In patients with Cushing's syndrome or morbid obesity, excessive accumulation of fat in the hips, upper back, abdomen, and mediastinum is well known (1, 3, 7). Excessive deposition of fat in the epidural space is less common, but must be recognized as a potential cause of neurological deficit (1-8). We report a patient with iatrogenic Cushing's syndrome, in whom magnetic resonance imaging (MRI) established the specific diagnosis of spinal cord compression secondary to excess epidural fat.

Spinal epidural lipomatosis: A serious complication of iatrogenic Cushing's syndrome

Neurology ◽  
1989 ◽  
Vol 39 (8) ◽  
pp. 1031-1031 ◽  
Author(s):  
J. G. Kaplan ◽  
E. Barasch ◽  
A. Hirschfeld ◽  
L. Ross ◽  
K. Einberg ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Spinal Epidural ◽  
Iatrogenic Cushing’S Syndrome

scholarly journals MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

2015 ◽  
Vol 173 (1) ◽  
pp. R1-R14 ◽  
Author(s):  
Cornelie D Andela ◽  
Femke M van Haalen ◽  
Oskar Ragnarsson ◽  
Eleni Papakokkinou ◽  
Gudmundur Johannsson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Magnetic Resonance ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Resonance Imaging ◽  
Biochemical Cure ◽  
The Brain ◽  
Active Disease

BackgroundCushing's syndrome (CS) is characterized by excessive exposure to cortisol, and is associated with both metabolic and behavioral abnormalities. Symptoms improve substantially after biochemical cure, but may persist during long-term remission. The causes for persistent morbidity are probably multi-factorial, including a profound effect of cortisol excess on the brain, a major target area for glucocorticoids.ObjectiveTo review publications evaluating brain characteristics in patients with CS using magnetic resonance imaging (MRI).MethodsSystematic review of literature published in PubMed, Embase, Web of Knowledge, and Cochrane databases.ResultsNineteen studies using MRI in patients with CS were selected, including studies in patients with active disease, patients in long-term remission, and longitudinal studies, covering a total of 339 unique patients. Patients with active disease showed smaller hippocampal volumes, enlarged ventricles, and cerebral atrophy as well as alterations in neurochemical concentrations and functional activity. After abrogation of cortisol excess, the reversibility of structural and neurochemical alterations was incomplete after long-term remission. MRI findings were related to clinical characteristics (i.e., cortisol levels, duration of exposure to hypercortisolism, current age, age at diagnosis, and triglyceride levels) and behavioral outcome (i.e., cognitive and emotional functioning, mood, and quality of life).ConclusionPatients with active CS demonstrate brain abnormalities, which only partly recover after biochemical cure, because these still occur even after long-term remission. CS might be considered as a human model of nature that provides a keyhole perspective of the neurotoxic effects of exogenous glucocorticoids on the brain.

Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature

2006 ◽  
Vol 4 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Yoshinori Ishikawa ◽  
Yoichi Shimada ◽  
Naohisa Miyakoshi ◽  
Tetsuya Suzuki ◽  
Michio Hongo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Japanese Orthopaedic Association ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Epidural Lipomatosis ◽  
Epidural Fat ◽  
Spinal Epidural

Object Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed. Methods Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI. Conclusions The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.

Posttraumatic Acute Spinal Epidural Hematoma of the Dorsolumbar Region

2020 ◽  
Vol 17 (01) ◽  
pp. 50-52
Author(s):  
Amit Agrawal ◽  
Uma Maheshwara Reddy V. ◽  
Kuraparthy Brinda ◽  
Luis R. Moscote-Salazar ◽  
Keerthana Dhanireddy
Keyword(s):  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Mri Imaging ◽  
Common Occurrence ◽  
Resonance Imaging ◽  
Epidural Fat ◽  
Uncommon Case ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

AbstractIn spite of the relative common occurrence of spinal injuries, spinal epidural hematomas (SEHs) are rare lesions. Depending on the onset, site, size, and presence of neurological deficits, they can be treated conservatively or surgically. In the presented article, we report an uncommon case of posttraumatic dorsolumbar SEH and discuss the characteristic magnetic resonance imaging (MRI) imaging findings of epidural fat in the cases of traumatic spinal hematomas.

scholarly journals Endoscopic Foraminotomy in Spinal Epidural Lipomatosis, Case Report

2019 ◽  
Vol 4 (06) ◽  
Author(s):  
Diego Quillo-Olvera ◽  
Jin Sung Kim ◽  
Javier Quillo-Olvera ◽  
Javier Quillo-Resendiz
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Radicular Pain ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Dural Sac ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Spinal Epidural

A 69-year-old woman with a history of hypertension and Cushing's syndrome, Her symptoms onset a year ago with pain in both legs treated with analgesics, but continued with right L4-L5 radiculopathy, she underwent treatment with endoscopy lumbar transforaminal, relieving his discomfort in the right leg, indicating on the visual analog scale (VAS) a score of 2/10. Four months later she started with pain in the left leg pointing to VAS of 7/10 in the disposition of the roots of L4-L5. Magnetic resonance imaging (MRI) of lumbar spine in sagittal and axial sequence weighted in T1 and T2 showed an excess of epidural fat and compression of the dural sac from L1 to S1. After the clinical-radiological assessment, the patient was treated with a left L4-L5 endoscopic foraminotomy in which adipose tissue was obtained and a decompression of the neural structures was achieved, the pain and weakness of the leg improved, indicated a VAS of 2/10 and the MacNab criteria scale for clinical graduation reported as good. We present a case of spinal epidural lipomatosis caused by Cushing's syndrome in a patient who underwent a lumbar endoscopic foraminotomy for radicular pain in a hospital in Korea.

scholarly journals Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

2001 ◽  
pp. 499-507 ◽  
Author(s):  
A Colao ◽  
A Faggiano ◽  
R Pivonello ◽  
FP Giraldi ◽  
F Cavagnini ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Cushing’S Syndrome ◽  
Imaging Techniques ◽  
Cushing's Syndrome ◽  
Resonance Imaging ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion

OBJECTIVE: To evaluate the diagnostic accuracy of inferior petrosal sinus sampling (IPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with pituitary imaging techniques. DESIGN AND METHODS: We retrospectively studied the diagnostic accuracy of basal and post corticotropin-releasing hormone (CRH) IPSS, magnetic resonance imaging and computed tomography in distinguishing pituitary from ectopic ACTH secretion in 97 Cushing's syndrome patients: 74 with Cushing's disease (CD) and 10 with ectopic ACTH secretion (EAS). Thirteen patients were excluded because of unconfirmed diagnosis. The difference between IPSS and pituitary imaging techniques in the correctly localized pituitary adenoma in the patients with CD was also investigated. RESULTS: The basal ACTH inferior petrosal sinus:periphery (IPS:P) ratio was > or = 2 in 63/74 patients with CD (85%), and in 1/10 EAS patients (10%); after stimulation with CRH, the ratio was > or = 3 in 60/68 patients with CD (88%) and < 3 in all patients with EAS. The basal and post-CRH ACTH IPS:P ratios had a diagnostic accuracy of 86% and 90% respectively. The diagnostic accuracy of IPSS with both ratios was significantly higher than magnetic resonance imaging (50%) and computed tomography (40%). The IPS:P ratio suggested by receiver-operator characteristic (ROC) analysis that better distinguished CD from EAS was 2.10 for the basal and 2.15 for the post-CRH ratios. Using these cut-offs, the specificity of basal ratio and the sensitivity of the post-CRH test rose to 100% and 93% respectively. Diagnostic accuracy remained substantially unchanged for the basal ratio (87% vs 86%), while it rose from 90% to 94% for the post-CRH ratio. The sensitivity of IPSS was significantly higher than that of magnetic resonance and computerized tomography. IPSS was less reliable in identifying the adenoma site found at surgery than magnetic resonance imaging or computed tomography (65% vs 75% and 79% respectively). CONCLUSION: In conclusion, IPSS improved the diagnostic performance of imaging techniques. It can help in excluding transsphenoidal surgery in EAS patients. More striking results were obtained when a > or = 2.1:1 basal ratio or a > or = 2.15:1 post-CRH ratio were considered as criteria to distinguish between patients with CD and EAS. To establish correctly the location of the pituitary adenoma, IPSS is less reliable than imaging techniques.

Posttraumatic Acute Spinal Subdural Hematoma of the Spine

2017 ◽  
Vol 14 (01) ◽  
pp. 053-055 ◽  
Author(s):  
Veldurti Kumar ◽  
Yashwanth Sandeep ◽  
Umamaheswara V. ◽  
Veda Samudrala ◽  
Amit Agrawal
Keyword(s):  
Subdural Hematoma ◽  
Spinal Injury ◽  
Cord Compression ◽  
Imaging Findings ◽  
Good Recovery ◽  
Resonance Imaging ◽  
Spinal Subdural Hematoma ◽  
Characteristic Imaging ◽  
Epidural Fat ◽  
Magnetic Resonance Imaging Mri

AbstractAcute spinal subdural hematoma (ASSH) is a rare cause of spinal cord compression and neurologic deficits. The authors report a case of 23-year-old male patient who developed ASSH following spinal injury and discuss the characteristic imaging findings of ASSH. Magnetic resonance imaging (MRI) of the spine showed hypointense collection on T2W images seen posteriorly extending from inferior endplate of C5 to superior endplate of D3 with preservation of the epidural fat signal. The patient underwent surgical evacuation of the hematoma and made a good recovery in his neurological functions.

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